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Literature on the Emergency Medical Services (EMS) has paid much attention to stressors, stress and symptoms, coping, and support of Emergency Medical Workers (EMWs). However, it has paid little attention to the needs of EMWs, and the satisfaction thereof, which should result in their improved well-being and motivation. In an attempt to rectify this imbalance, this study investigated the needs of EMWs as suggested by descriptions of their experiences within the EMS. Interviews were conducted with EMWs employed by a private EMS company. The interviews were analysed for emerging needs by means of interpretive analysis. These needs comprised the Need for Freedom, the Need for Competence, the Need for Recognition, the Need for a Challenge, and the Need to be Understood. The findings were linked with theory and it is proposed that the relevant EMS company incorporates participative management into its management approach. In addition suggestions are made for future research. / Psychology / M. A.(Psychology)

Literature on the Emergency Medical Services (EMS) has paid much attention to stressors, stress and symptoms, coping, and support of Emergency Medical Workers (EMWs). However, it has paid little attention to the needs of EMWs, and the satisfaction thereof, which should result in their improved well-being and motivation. In an attempt to rectify this imbalance, this study investigated the needs of EMWs as suggested by descriptions of their experiences within the EMS. Interviews were conducted with EMWs employed by a private EMS company. The interviews were analysed for emerging needs by means of interpretive analysis. These needs comprised the Need for Freedom, the Need for Competence, the Need for Recognition, the Need for a Challenge, and the Need to be Understood. The findings were linked with theory and it is proposed that the relevant EMS company incorporates participative management into its management approach. In addition suggestions are made for future research. / Psychology / M. A.(Psychology)

This study was designed to determine if a need exists to teach decision making skills to paramedic students in San Bernardino County.

Thesis (M.Tech.: Emergency Medical Care)- Dept. of Emergency Medical Care and Rescue, Durban University of Technology, 2008. xii, 149 leaves, Appendices A-I. / Prehospital emergency medical service (EMS) data is essential for understanding the functioning of the services as well as the community's health. Being able to clearly and accurately define the patient population in terms of demographics and clinical condition may guide the EMS in resource management, clinical governance, research, education and political decisions. However, such data is limited in South Africa. This research, therefore, aimed to develop a data collection tool to determine the population of prehospital emergency medical care patients in South Africa. The objectives were: (i) determination of what data needed to be collected, (ii) development of a tool to collect the data, and (iii) testing the tool for ease and appropriateness of use and completeness of data collection in an authentic environment. A mixed-method, predominantly qualitative methodological design was used, with some elements of grounded theory. There were three phases corresponding to the objectives. The first two were qualitative and the third was both qualitative and quantitative. In the first phase expert consensus was sought, using a focus group discussion and Delphi study, to develop a minimum data set (MDS) to describe the patient population. The resultant MDS consisted of 18 data elements which could be categorised into demographics, time and location of EMS use, the clinical reasons for EMS use, and the actual use of the EMS. A tool and associated user instructions, based on the findings of Phase One, were developed and refined during Phase Two. Phase Three was used for testing the tool in an authentic environment. The tool was found to be acceptable and user-friendly. Further testing of the tool for accuracy and reliability is recommended.

Sepsis and its manifestation as a shock state in “septic shock” have long caused medical issues and death worldwide. The disease requires quick identification, diagnosis, and intervention with very high mortality rates prevalent otherwise. Historically this has been due to limited awareness of the disease and misclassification of its prevalence, severity, and incidence. Luckily in the past decade there has been increased interest and therefore resources devoted towards improving care and further understanding a disease that is one of the leading causes of mortality in hospitals worldwide. Over the past handful of years novel interventions and diagnostic techniques have become available. Unfortunately, in many cases these new discoveries have not yet trickled down to many of the providers on the frontline and a large amount of variation in care exists across the country. Because of the time sensitivity of sepsis, it is imperative that individuals working in the areas of healthcare who first come in contact with these patients have a clear understanding of the newest advances and resources available. In this thesis the goal is to first analyze the current protocols and standards of care for sepsis and then secondly consider new developments available both in the hospital and in prehospital emergency medical services (EMS). From the current information, strategies and protocols based on improvement of patient outcomes, can be streamlined and optimized moving forward. As predicted, there is currently an incredibly large amount of variation and knowledge on the subject with some areas implementing very progressive protocols while others still lack a sepsis protocol all together. In general, the current consensus in the field is that rapid identification and initiation of treatment is the most important component to long term survival. Improvement of outcomes therefore relies on standardization of protocols with incorporation of education components for healthcare providers. This aims to raise awareness and encourage utilization of the newest information and suggestions available. Increased interdisciplinary cooperation between prehospital providers in EMS and care providers in the hospital can also lead to improvement of recognition and treatment times for these patients. Future considerations were also examined that may potentially be applicable moving forward to improve these standards even further. There is a much opportunity available in each of these areas currently and progress is key to improving outcomes.

An Intensive Care Unit (ICU) is an extreme technological environment where different t)?es of equipment and devices, intended for the care of critically ill patients, are found. The use of technological equipment has assisted in reduction of morbidity, mortality, and length of hospital stay because the problems are diagnosed earlier. The purpose of the study was to explore the perceptions of nu$es who work in the Intensive Care Units about the effects of the use of technological equipment, with the intention of making recommendations for clinical practice, education of nurses and further research. A quantitative, descriptive, prospective, and non-experimental study design was utilised in this study, as well as a non-probability sampling method. Participants (n:60) were drawn from neurosurgical, cardiothoracic and main ICUs. Data collection was done by use of questionnaire. Descriptive and inferential statistics were used to analyse data.

Effective teamwork has been shown to optimize patient safety. However, teamwork research in Emergency Medical Services (EMS) is sparse. Before successful interventions can be implemented, the appropriate content of such interventions should be determined. We tested the applicability of a teamwork processes framework in emergency care (Fernandez et al., 2008) to the EMS context. We recruited participants from an EMS agency in Houston, TX, using purposive sampling. Full-time employees with a valid EMT/paramedic license were eligible. Using semi-structured format, we queried respondents on task/team functions and enablers/obstacles of teamwork in EMS. Phone interviews were recorded and transcribed. Structural coding was based on our theoretical model. Through a deliberative process, we combined codes into candidate themes. Analytic memos during coding and analysis identified potential themes, which were reviewed/refined, and compared against our framework. We reached saturation once 32 respondents completed interviews. Among participants, 30 (94%) were male; the median experience was 15 years. Our analysis identified the team processes in the Marks’ Teamwork Process Model in four domains: Action, Planning, Reflection and Interpersonal Processes. Additionally, the concepts cited as being central to team effectiveness in EMS were: leadership, crew familiarity, team cohesion, interpersonal trust, shared mental models, and procedural knowledge. The revised model was useful for describing teamwork processes that providers employ to drive performance in EMS. Additionally, we identified emergent concepts that influence teamwork processes in EMS. Our findings inform our understanding of teamwork processes in EMS, and may be useful in guiding future team-based interventions tailored to EMS. / 2019-11-08T00:00:00Z

This study has used a mixed methodology to explore the impact of geographic, temporal and ambulance crew skill factors on ambulance clinicians’ decisions to leave a patient on scene after attending a 999 call. Four phases of work were undertaken using both qualitative and quantitative methods to build an understanding of the complex nature of pre-hospital clinical reasoning. A novel scale, the DMASC survey was developed, which indicated four factors influence decision-making in this context. More experienced staff scored significantly differently to other staff groups on the ‘Experience’ and ‘Patient characteristic’ subscales of the tool. Qualitative work explored these findings in more detail and five inter-related themes were identified, namely, ‘Communication’, ‘The three ‘E’s’, education, experience and exposure’, ‘System influences’, ‘Professionalism’ and ‘Patient characteristics’. The final phase of the study undertook to analyse retrospective call data from one large ambulance service over a one-year period. All of the five predictor variables, rurality, time of day, day of the week, patient condition and crew skill level, influenced the likelihood of conveyance. Of these the level of clinical skill of the first crew at scene was independently significant. The results of this work are discussed in relation to the strategic and operational context of NHS ambulance services. The thesis is structured as a series of papers yet to be submitted for publication. Although this confers a degree of repetition, it provides a logical analysis of the methods used to explore factors that may influence paramedic’s clinical decision making when deciding to leave patients at home following a 999-call attendance.